腰椎间孔镜的应用解剖
Applied anatomy for transforaminal endoscopic lumbar surgery
目的 为不同节段腰椎间孔镜手术提供解剖学依据。 方法 10具成人脊柱腰骶段（L1～S1）标本，观测L1/2～L5/S1椎间孔高、椎间孔安全三角、椎管内安全三角的形态。 结果 ①L1/2～L5/S1椎间隙水平中线与椎间孔安全三角高的交点到出行神经根的距离为（4.75±0.80）、（6.42±0.44）、（7.30±0.82）、（7.74±0.52）、（4.68±1.27）mm；②L1/2～L5/S1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到出行神经根的距离为（4.02±0.78）、（4.67±0.65）、（5.17±0.91）、（6.16±0.74）、（5.48±0.61）mm；③L1/2～L5/S1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到硬膜囊/走行神经根的距离为（3.89±0.61）、（4.39±0.71）、（5.17±0.97）、（6.58±0.70）、（6.22±1.20）mm。 结论 掌握腰椎不同节段的解剖特点，有利于椎间孔镜手术时合适尺寸工作套管的选取。
Objective To provide data for transforaminal endoscopic lumbar surgery at different levels. Methods Anatomic structures, including the height of intervertebral foramens,the morphology of safety triangle of intervertebral foramen and safety triangle of spinal canal on 10 adult cadaver spine specimens (L1～S1) were observed and measured. Results ①The vertical dimension between the intersection of a horizontal line drawn through the middle of disc space and the tip of the safety triangle of intervertebral foramen and the exiting nerve root at L1/2～L5/S1 were (4.75±0.80), (6.42±0.44), (7.30±0.82),(7.74±0.52) and (4.68±1.27) mm; ② The distance between the intersection of a horizontal line drawn through the middle of posterior margin of disc and the vertical line drawn through the medial one third of the pedicle and the exiting nerve root at L1/2～L5/S1 were (4.02±0.78), (4.67±0.65), (5.17±0.91), (6.16±0.74) and (5.48±0.61) mm; ③ The distance between the intersection of a horizontal line drawn through the middle of posterior margin of disc and the vertical line drawn through the medial one third of the pedicle and the thecal sac/traversing nerve root at L1/2~L5/S1 were (3.89±0.61), (4.39±0.71), (5.17±0.97), (6.58±0.70) and (6.22±1.20)mm. Conclusions Understanding detailed anatomic features of lumbar vertebrae is valuable for choosing a suitable working cannula during transforaminal endoscopic lumbar surgery.
Lumbar vertebrae / Safety triangle / Transforaminal endoscopic / Applied anatomy
[1] 赵伟, 李长青, 周跃, 等. 经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症[J]. 中国矫形外科杂志, 2012, 20(13):1191-1195.
[2] 柳百炼, 熊鹰, 顾邵, 等. 经皮椎间孔镜治疗腰椎间盘突出症的临床效果[J]. 实用医学杂志, 2015, 319(6):981-983.
[3] Gadjradj PS, van Tulder MW, Dirven CM, et al. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation:a prospectivecase series[J]. Neurosurg Focus, 2016, 40(2):1-7.
[4] Kim CH, Chung CK, Sohn S, et al. The surgical outcome and the surgical strategy of percutaneous endoscopic discectomy for recurrent disk herniation[J]. J Spinal Disord Tech, 2014, 27(8):415-422.
[5] Kambin P, O'Brien E, Zhou L, et al. Arthroscopic microdiscectomy and selective Fragmentectomy[J]. Clin Orthop Relat Res, 1998, (347): 150-167.
[6] Mirkovic SR, Schwartz DG, Glazier KD, et al. Anatomic considerations in lumbar posterolateral percutaneous procedures [J]. Spine, 1995, 30(18): 1965-1971.
[7] Park JW, Nam HS, Cho SK, et al. Kambin's triangle approach of lumbar transforaminal epidural injection with spinal stenosis[J]. Ann Rehabil Med, 2011, 35(6):833-843.
[8] 何尚宽, 徐达传, 王义生, 等. 经皮穿刺L5～S1椎间盘髓核摘除入路的应用解剖[J]. 中国临床解剖学杂志, 1993, 11(3):168-170.
[9] Deen H. Posterolateral endoscopic excision for lumbar disc herniation:surgical technique, outcome, and complications in 307 consecutive cases[J]. Spine, 2002, 27(18):2081-2082．
[10]Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminarand transforaminal lumbar discectomy versus conventional microsurgical technique:a prospective, randomized, controlled study[J]. Spine, 2008, 33(9):931-939．
[11]白一冰, 徐岭, 赵文亮, 等. 经皮腰椎间孔镜手术的穿刺定位策略[J]. 中国微创外科杂志, 2012，12(6):540-543.
[12]Ahn Y, Lee H, Lee S, et al. Dural tears in percutaneous endoscopic lumbar discectomy[J]. Eur Spine J, 2011, 20(1):58-64．
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